Payment Integrity Auditor

Waltham, MA /
Operations /
Full-Time
A bit about us: 

We’re on a mission to change healthcare — how it’s paid for, delivered, experienced. We want to put people center stage, not process or profit. We are guided by a deep belief that every person on Medicare should be treated like we would treat a member of our own family: with loving care and a profound commitment to their health and well-being. 

That’s why we’re gathering a whole bunch of smart, big-hearted people to create a new kind of healthcare company — one that combines compassion, health insurance, clinical care, and technology seamlessly. 

We want to throw the long ball with people we love for a cause we believe in. Life is short. Join us.


Why Devoted:

Make a difference... a big difference. You will have the opportunity, in a unique and dynamic culture, to be a part of something incredibly meaningful. We’re a disruptive startup with an inspiring mission. Learn and grow alongside our world-class team of healthcare, technology, and data leaders, dedicated to building a health plan and clinical services that care for everyone like they were our own mothers or fathers. Our team and board members have decades of experience in health care entrepreneurship, data, technology, services, and policy. With their support, we look forward to building a health plan and clinical services that will give seniors easy access to the high-quality care they deserve.

A bit more about this role:

At Devoted, we know that one of the most important ways we will build trust is by ensuring we can pay claims accurately and on time, while providing the strategic flexibility to change payment models. Our Payment Integrity Operations team is responsible for managing Claim audit and adjustment functions and driving projects to prevent repetitive errors.  Devoted is committed to building a team of people, effective processes and proprietary technology that delivers industry leading claims payment, accuracy and provider satisfaction. Devoted Health is building the core technology platform from the ground up. The Payment Integrity Auditor is responsible for developing audit concepts, vendor management and validation of over-payment identifications, performing root cause analysis, and  proposing improvement projects to prevent repetitive errors. This position will  ensure overall quality of audit functions and summarize findings across all programs and vendors  and be responsible for  presenting monthly results.

Responsibilities will include:

    • Develop and manage audit processes, policies, and work streams for internal and vendor audit activities ensuring target goals are met
    • Create standard operating procedures and payment policies to support audit  and recovery activities
    • Identify and develop  audit concepts that target highest risk claims
    • Coordinating with clinical team for clinical validations audits
    • Work to identify, document, and propose solutions for areas of improvement
    • Develop, implement, and maintain worksheets that support the overall details of the PI programs within the claims department
    • Coaching and mentoring team members
    • Perform other duties as assigned to support claims functions.

Attributes to success:

    • Curiosity and willingness to ask questions
    • A deep desire to improve and make a change in the healthcare experience
    • Preference towards collaboration and preventing silos
    • You will roll up your sleeves and do whatever it takes to get the job done
    • Ability to work in a fast-paced start-up environment

Desired skills and experience:

    • 5-7 years experience in a claims auditor role with responsibilities across multiple Payment Integrity disciplines including Subrogation, COB, FWA/ SIU, Data Mining, DRG, HBA, Credit balance etc
    • 3-4 years experience with Identification, development and testing of audit query concepts
    • Excellent ability to build and maintain positive relationships with business and 3rd party partners 
    • Experience with performing root cause analysis of claim payment errors 
    • Strong written, verbal, and interpersonal communication skills required
    • Excellent spreadsheet and database skills required, SQL a plus
    • CPC (Certified professional coder) also a plus
If you love running towards complex challenges and transforming them into solutions, if you want to make a potentially huge impact on many lives, and if you are looking for a disruptive startup with an inspiring and talented team, Devoted Health may be the place for you! 

Devoted is an equal opportunity employer.  We are committed to a safe and supportive work environment in which all employees have the opportunity to participate and contribute to the success of the business. We value diversity and collaboration. Individuals are respected for their skills, experience, and unique perspectives. This commitment is embodied in Devoted’s Code of Conduct, our company values and the way we do business.

As an Equal Opportunity Employer, the Company does not discriminate on the basis of race, color, religion, sex, pregnancy status, marital status, national origin, disability, age, sexual orientation, veteran status, genetic information, gender identity, gender expression, or any other factor prohibited by law. Our management team is dedicated to this policy with respect to recruitment, hiring, placement, promotion, transfer, training, compensation, benefits, employee activities and general treatment during employment.